What’s in a Name?

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How can we know when seemingly insignificant events in our life will impact our lives in ways we do not foresee? We can never know; it is only years later, when we look back and gain perspective do we gain appreciation.  The experience I would like to share was not earth-shaking or what one might describe as particularly profound; rather, it was merely one of those light, amusing life experiences.  Nonetheless, it was an experience that I recall with a smile, and an experience that has helped my vision in naming this blog.

It was 2006. My wife, son and I stepped forth from our rented apartment on the first day of a long awaited trip to Italy. Gabe had been studying the Renaissance in his elementary school “challenge class” and Anne and I had, in the distant past, both had formative experiences in childhood or college while in Europe. It had been many years since we had been in Europe, and it was Gabe’s first time.

It was a bright beautiful morning in May. We walked down a bustling street in Rome, and looking for a place for breakfast, we spied a busy cafe and entered to sights of wonderful looking pastries and the rich smell of espresso. We pointed, smiled and attempted a word or two of very rudimentary Italian to indicate which pastries we were interested in. And then I ordered my coffee.

Anyone who knows me knows I like coffee. I drink a fair amount of coffee, but it is not as though I drink pots and pots of it.  I like it strong, I like it black,  and I like it in those tiny little espresso cups so I can savor it, nice and hot.  Upon first glance at the small espresso coffee cups in the Italian cafe that day in 2006, it was quickly apparent to me that even a “double” espresso was not going to be adequate; so I ordered a “triple.”

“Tre?! Tre?! No, doppio. ”  The Italian man said, shaking his head emphatically.

I learned right away that a “triple espresso” was not allowed. Judging by the look of surprise in his eyes, it was as if I had asked the impossible. It was single or double. I attempted to explain that I really did want a triple espresso; but no, sorry, a triple was just not an option.  I ordered a double (doppio) espresso, enjoyed it immensely, and  then went on to order another double espresso.

This experience was one of those funny little events that happen while traveling. I’ll never forget the look of surprise in the Italian man’s face as I asked for that triple espresso. I didn’t know it at the time, but the stage had been set for “Triple Espresso MD” to be born. Not long ago,  Anne and I were bouncing different names for the blog off each other, and perhaps because we were once again traveling in Europe, in a moment of inspiration she exclaimed, “Triple Espresso MD!”  It was instantly clear she had hit upon the perfect name for my blog.

I think it is safe to say that proposing a “triple” espresso that day in Rome was not exactly a brilliant insight or a think-outside-the-box new idea. I merely wanted what I thought was an adequate amount of coffee. Still, “triple espresso” symbolizes to me an attempt to look at issues a little differently, from a fresh and creative perspective. In addition, the name is imbued with a sense of humor and makes me smile. And of course, lets not forget that espressos are packed with energy; it is my hope that this blog energizes readers to live a healthy life.

“Triple Espresso MD” is a place for creative and fresh perspectives on health and medicine. I you enjoy it as much as I enjoy my espresso!

Lost Stories

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img_2661Not far from the busy pedestrian streets in the center of Vienna, down a quiet narrow street, lies a small cobblestoned city square. Before World War II, this city neighborhood was the bustling, vibrant heart of Vienna’s Jewish Quarter, but today it is has a quiet, almost subdued feeling. Vienna’s current Jewish population is only a small fraction of what it was before the war, and the quiet feel of the square reflects this.

At one end of the square is a memorial to the thousands of Jewish individuals who lost their lives during the Holocaust. At first glance, the memorial looks like a huge square concrete block, oversized and awkwardly placed in an otherwise well-proportioned city square. As one approaches however, the details become more clear: the memorial is a library of books. But in contrast to how books are normally displayed, the books are turned inward such that the spines are in the center of the concrete block, hidden from view. Walking the perimeter of the memorial, the observer sees only the outer edges of the pages – no spines to reveal the titles or authors.

To view this memorial is thought provoking and very moving. The library symbolizes the lost stories of the Holocaust: humanity lost scientists, poets, artists, musicians, teachers – countless unique individuals who possessed knowledge, gifts, and skills that could have added to the diverse richness of humanity.  A library of humanity, knowledge and gifts, hidden from view and lost forever.

The image of the Jewish Memorial and the feelings it brought forth washed over me as I read about the many ways in which the medical profession – and human health – has benefited from the natural world. Many important, life saving medicines are derived from plants and animals in nature. For example, blood pressure and diabetes medications, cancer treatments, and blood thinners all are derived from chemicals discovered within plants or animals. In addition, modern medicine has looked to the natural world for inspiration and models for many significant advances.

However, this rich and diverse fund of knowledge – this library – is disappearing at an alarming rate. Biologists warn that Earth is losing species at an unprecedented rate, such that our current era has been called “the sixth extinction.” With every lost plant or animal, humanity  loses unique tools, lessons and examples that could help human health. In addition, as we lose biodiversity, we also become less able to adapt to changes in our environment, becoming handicapped in our ability to respond to new diseases.

Much of the Holocaust occurred while the world’s nations looked the other way, ignoring the unprecedented loss of life. Similarly, as species disappear on a daily basis in today’s world, most of us go about our daily life, attention turned elsewhere.  Humanity can not afford to ignore this destruction of the natural world. Human health will increasingly suffer from the loss of knowledge the natural world offers, and just as countless human stories were lost during the holocaust, we will lose the stories from nature that could help us live a healthy life.

There is not a simple solution to halt our current loss of biodiversity, but we all must do what we can. Every little bit helps; we can drive less, recycle, and support  laws, politicians, and businesses that value the environment, for example.

The time for action is now. The health of the natural world and the health of humans are intimately intertwined, and ultimately will enjoy or suffer the same fate.

Interconnectedness And The Flu Vaccine

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vaccineI received my flu shot the other day. I love getting vaccines. Vaccines prevent disease and help keep me healthy. To me, getting that poke in the arm gives me a feel-good sense of interconnectedness with others. I know it seems at first a little odd to make this comparison, but for me it’s true. Getting a vaccine helps keep me well, and makes me happy knowing that by not getting the flu I am keeping others healthy. Not only do I feel cared for as an individual, but in getting that shot, I enjoy a sense of caring for others.

And when it comes to caring about our community, kudos to our own Kittitas Valley Healthcare organization for working hard to prevent patients from getting the flu. KVH has adopted a very strong influenza vaccination policy, in that if a KVH employee chooses not to get the influenza vaccine, they are required to wear a mask throughout the flu season (from November 1st through March 31st!).

Getting the influenza vaccine as a healthcare worker is very important; research has shown that healthcare workers who get the flu risk infecting their patients, which can result in serious illness and death. For example, research on this topic has compared nursing homes with high rates of influenza vaccination among staff to nursing homes where staff had lower rates of vaccination. The nursing homes that had low staff influenza vaccination rates had significantly higher influenza related deaths among the residents. In other words, getting the influenza vaccine not only keeps healthcare workers healthy, but protects the people they care for.

Similarly, when a individual in our community gets the influenza vaccine, they not only  improve the chances of not getting the flu themselves, but also of not giving it to others they come into contact with. Regardless of our profession or daily activities, we inevitably interact with other community members, some of whom may have medical conditions that make them more vulnerable to getting sick with influenza. For example, it’s almost impossible to know if the person we stand in line with at the grocery store has cancer and is taking medicine that suppresses their immune system. Why take the chance of getting someone else sick?

My advice is to take action to keep yourself, friends, family, and fellow community members healthy. Get the influenza vaccine. In addition to being healthier, by receiving the vaccine you promote the health of others. Take a moment to reflect upon what that vaccine is doing not only for yourself, but for every person in your life.

Gun Violence: A Public Health Crisis

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We can use the scientific process…to help us learn how firearms can be safer. 

The numbers are daunting. Over 33,000 people die from guns in the United States each year, more than any other industrialized country.  The homicide rate in our country is twenty times higher than countries similar to ours. While mass shootings are occurring at increasing frequency and dominate newspaper headlines, most deaths –two thirds– are from suicide.  And perhaps most disturbing is that children less than 18 years old in America die from guns at a rate that is eleven times that of other countries; suicide is the second most common cause of death for our youth.

I tend to look at health and medicine from an optimistic, “glass half full” perspective. For most health topics, I find it relatively easy to take this perspective.  However, it is difficult to do so with gun violence.  Put bluntly, there is nothing good guns do for human health. Every death from firearms is tragic, sudden, and disturbing. Every death from firearms did not have to happen.

I also like to look at health recommendations from what is considered an “evidence-based” perspective. “Evidence- based” means that recommendations are based on scientific evidence and research. The scientific process attempts to look at questions from an objective viewpoint, and continually reevaluates previous conclusions to confirm their accuracy. Using science to guide us is our best chance at knowing what “works” for health problems.

Americans own more guns per capita than any other industrialized country in the world. Meanwhile, the second amendment protects the rights of Americans to bear arms. These facts will not change. What can potentially change, however, is the creation of a safer environment in which guns and people coexist. My hope– my “glass half full” perspective–  is that by approaching firearm safety as we have other public health issues, we can come together as a nation and take rational, evidence based actions to reduce harm from firearms.

By reviewing past public health challenges, our country can learn how to reduce deaths from firearms. A good example is how we have approached harm caused from motor vehicle crashes. Because of research studies, we learned that wearing seat belts and having airbags save lives. Meanwhile, the statistics have overwhelmingly supported the notion that driving intoxicated increases the risk of being killed — and killing others– in motor vehicle crashes. As a result, laws were enacted that required cars to be made with airbags, drivers to wear seat belts, and that have enforced not driving intoxicated. Even more importantly, because of what has been learned through research, driving culture has changed. It is not acceptable in our country to drive drunk or without a seatbelt. In other words, research illuminates important health and safety facts, laws support those facts, and behaviors change.

Similarly, if we ask questions and arrive at answers through objective research studies, we can use the scientific process as an important tool to help us learn how firearms can be safer in the United States. Already we know that gun safes and locks reduce suicides and accidental shootings in the home, but we need to learn more. We need to use scientific, evidence-based research to learn what other interventions can help make the presence of firearms in the home safer.

In our current era of political divisiveness, it is time to come together as a country to reduce gun deaths. Gun violence in America is a complex problem and solutions are often not simple, but if we approach this topic as we do other public health topics, and utilize an evidence-based perspective, as a country we may be able to make progress in reducing the number of deaths each year from firearms.

Listen in on my discussion with Dr. Mark Larson on “Gun Violence as a Public Health Problem”.

Above the Clouds

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cloudsRecently I was graced by the presence of a friend who is in the midst of battling cancer. It was a very special privilege, a reminder of how precious we each are, and how every day is a gift.

To have an aggressive or advanced cancer and to meet it head on transports that person and their loved ones into a different state of being. Most people not facing a life threatening disease go about their daily life with an underlying sense that the future is measured in many years. There is time to think about what might happen next year, to plan for retirement; there is time to day dream about the future. But cancer changes all that. What is important is now: family, friends, the warm sun and the beautiful blue sky. Now is so very precious and important. Now is the time to tell your spouse you love them, to notice and share the beauty in your child. The present is alive with the beautiful energy of life and love. It is almost as if the people without cancer are living on the surface of the earth, below the clouds on a partly sunny day, while those absorbed in the intensity of living with cancer have the opportunity to rise up and see those clouds not from below, but from above, to experience the radiant blue sky and the brilliance of the tops of white clouds and bright sunlight.

I know this heightened awareness of living, as my life was once acutely threatened by cancer. I felt uncertainty and fear, but when I was able to move through and above those feelings, I experienced a clarity of perspective, a vivid awareness of the beauty of life. I know it, I have lived it, but am not there now. As far as I know, if my good fortune continues, I am free of my cancer. Over the past couple of years, I have gradually rejoined the cancer-free crowd, and as such have slipped into the inevitable routine of thinking and feeling too often into the future. Because I am not acutely threatened as I once was, I have slipped out of that special, heightened state of being. I love to appreciate the present and try to take nothing for granted, but it is not the same. There is no substitute for the real thing.

Spending an hour with this very special person who was immersed in the cancer experience, whose eyes sparkled as she smiled at her daughter and told her husband she loved him, was truly a gift. It reminded me of my experience, and how important it is to strive – all of us – to experience and appreciate life to the fullest. Just by trying, we can make our lives and the lives of those around us that much more close to that special, almost divine, state of being.

Past and Present: Rubella and Zika

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Dengue, zika and chikungunya fever mosquito (aedes aegypti) on human skin

The past can teach us important lessons if we are observant. This is especially true for infectious diseases and the power of immunizations. Vaccines have turned diseases of epidemic proportion into distant memories; it is critical to remember these past events and to use their lessons to guide us as we face new health challenges today.

I invite you to travel back in time. It is the winter of 1964, and Philadelphia and New York are the epicenters of a worldwide viral epidemic that has swept into America from Europe. Transmitted like the common cold, the viral infection is typically not severe. Those afflicted experience a sore throat, watery eyes, and a faint rash, followed by complete recovery. However, if the infection occurs early in pregnancy, the consequences for the developing baby are potentially catastrophic. One percent of infants born to mothers who acquire the infection during the first few months of pregnancy are born with severe birth defects; most of the affected babies experience deafness, heart defects, and cataracts, but virtually every organ of the developing infant can be affected. Twenty thousand babies are born with these abnormalities, and eleven thousand die.  This is the story of the Rubella Virus.

Fast forward to present day, Miami. A viral epidemic is sweeping into the United States from South America. While this virus is transmitted by a mosquito, it also produces mild symptoms: a sore throat, sore joints, and a faint rash.  Many people are not even aware they have been infected. And yet, like the Rubella Virus, an infection that occurs early in pregnancy can be devastating. One percent of infants born to mothers who acquire the infection early in their pregnancy will give birth to babies with severe birth defects, most commonly microcephaly.

The epidemic is happening now and the future is unclear. This is the unfolding story of the Zika Virus.

The epidemic that swept America in 1964 is uncanny in its similarity to what is happening today. Will twenty thousand newborns be born with severe birth defects, as in 1964?

Let’s travel back in time again. Returning to Philadelphia, it is 1969 and a vaccine has been developed. Due to vaccination efforts, by 2004 the Rubella Virus that spread into America from Europe has been completely eradicated from The United States. And just last year, in 2015, the virus was declared eradicated from the Americas.  This is the happy ending to the story of Rubella, and a testimony to the power of vaccines.

As of today, 2016, there is no vaccine for the Zika Virus that is spreading into the northern hemisphere from the south. We need a vaccine, as it will be the ultimate cure. And yet, in the present day United States there are individuals who are skeptical about the benefits of vaccines.

The past is a powerful teacher. As Zika knocks at our door, one only needs to pause and remember the story of Rubella. The benefits of vaccines become crystal clear.

The Skinny On Weight Loss

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Losing weight is hard work, but…it is worth the effort.

For many people, losing weight or maintaining a healthy weight is very challenging.  To make a difficult process worse, there is a plethora of weight loss advice, diets, and supplements to choose from; weight loss diets are a big business and everyone has an opinion.  Attempting to lose weight in our country seems much more complicated and confusing than it needs to be. To help sort out fact from fiction, it helps to look at what good quality medical research says about weight loss.

Diet.  This topic is perhaps the most important– as well as most confusing– topic to address.  What type of diet should one follow? Many medical studies have been done in an attempt to address this question.  The conclusion is that no one diet is superior to another. While a specific diet may claim theirs is the best (and may present a rationale that seems to make sense), no specific diet is more effective than any other. What is important though, is picking a diet that makes sense to you as an individual, and sticking with it.  If a diet with reduced calories is followed, weight is lost.  No matter how one looks at this topic, weight loss boils down to paying attention to what one ingests and ingesting less calories.  Not surprisingly, once a specific diet is stopped, weight is typically regained.  This weight regain is because less attention is paid towards what one eats, and more calories are ingested.

How many calories an individual should try to reduce from his or her diet depends on how overweight one is, and how aggressive a weight loss program they wish to pursue.  For most people, reducing caloric intake by 500 calories per day will result in a gradual, steady weight loss.

Exercise. While the health benefits of exercise are immense, medical research has shown that exercise has a relatively small impact upon successful weight loss. Weight loss is best achieved through reduced calories. With that said, exercise is quite helpful at maintaining a new weight once one has lost weight. In addition, exercise helps build muscle and reduces the chance of developing many diseases, such as heart disease, diabetes, arthritis, and even some types of cancer.

There are a number of common perceptions regarding weight loss that may be true, but in which the jury is still out. For example, in general, the medical research supports the notion of ingesting most of one’s calories by the afternoon, and avoiding a large dinner.  However, we don’t know for sure how important this is for weight loss. Similarly, the importance of eating breakfast is traditionally recommended to help with weight loss, but the medical research has not given us a clear answer regarding how important this is either.

We do know that over the counter supplements have no proven benefit with weight loss. Prescription medications are of limited use and must be taken indefinitely to help with weight loss. Bariatric surgery clearly helps, but is indicated in only in very specific situations, and as is the case with any major surgery, there is a very real risk of serious surgical complications.

Losing weight is hard work, but it is attainable and worth the effort. My advice is to keep it simple, and to go with what scientific research supports.  Pick a diet–or strategy– that seems right for you. Reduce your daily caloric intake by about 500 calories, and stick with your plan for the long haul. Make your lifestyle changes permanent, otherwise lost weight will probably be regained.  Meanwhile, work exercise into your life, which will help keep the weight off. If after sincere effort you are still having difficulty with weight loss, consider seeing your doctor to discuss other options.

It would be nice to have a “magic bullet” that makes weight loss effortless and lasting.  While there is no such special supplement or proprietary diet that makes it easy to lose weight, there is a refreshing simplicity to the advice medical research has to offer.